Loop Ileostomy Closure After Prior Laparoscopic vs. Open Surgery: Is There a Difference?

Introduction: Temporary loop ileostomy is commonly performed to protect distal anastomoses during both open and laparoscopic colectomies . The aim of this study was to evaluate the impact of initial open and laparoscopic colorectal resection on the outcomes of ileostomy closure.

Methods and Procedures: After Institutional Review Board approval all patients who underwent loop ileostomy closure from 01/08 to 07/10 were identified from a prospective database. Patients’ demographics, diagnosis, ASA classification, diagnosis, type of resection, approach (laparoscopic –LS and Open – OS), use of anti adhesive barrier and ileostomy closure outcomes were obtained from chart review. The outcomes of ileostomy closure after LS and OS colorectal resections were compared using Chi- square and Student’s t test for categorical and continuous variables, respectively; a p value < 0.05 was considered statistically significant.

Results: 356 patients (213 males, 143 females) of a mean age 50.6 (14 -89) years were identified. There were 206 (57.8%) patients in the LS and 150 (42.1%) the OS groups. The 2 groups had comparable demographics, mean BMI (25.3 kg/m²), ASA class (70% ASA II), diagnosis (malignant, benign) and anti-adhesion barrier use (11 OS, 4 LS). The most common procedures performed were total proctocolectomy with ileal J pouch anal anastomosis in 130 (63 LS, 67 OS) patients followed by restorative proctectomy in 115 (47 LS, 68 OS). At the time of ileostomy closure, patients in the LS group had significantly shorter mean operative time, (LS 60.8 vs. OS 82.5 min, p <0.001) and length of hospital stay (LS 4.9 vs. OS 5.8 days, p= 0.042). In addition, conversion to midline incision occurred in 6 patients, all of whom had prior OS. The overall complication rate was 16% (57 patients), which was significantly higher in the OS group compared to the LS (75.4% vs. 24.5%, p=0.003).The most common complications were postoperative ileus in 36 patients (27 OS vs. 9 LS) followed by enterocutaneous fistula in 5, all in the OS group.

Conclusion: Loop ileostomy closure following laparoscopic colorectal surgery is associated with significantly shorter operative time, hospital stay, conversion to midline incision and postoperative complications compared to open surgery. Superior outcomes after loop ileostomy closure lends further support to the use of laparoscopy.